Preoperative High FIB-4 Index and NFS Scores Predict a Reduced Incidence of Metachronous Liver Metastasis Following Pancreaticoduodenectomy

Background/aim: Liver metastasis (LM), pre-dominant in pancreatic cancer, is associated with a dismal 5-year survival rate. Reports on the presence of fatty liver and liver fibrosis in LM are conflicting. Although liver biopsy is the standard diagnostic method for fibrosis, alternative, less invasive scoring models have been explored. This study examined the relationship between preoperative liver conditions and metachronous LM in patients undergoing pancreaticoduodenectomy (PD) for pancreatic head cancer.

Patients and methods: We conducted a retrospective study on patients with pancreatic head cancer who underwent surgery at a single University Hospital between 2008 and 2023. The primary focus was the effect of preoperative liver conditions on LM recurrence. We compared clinical variables between groups with LM recurrence and those with extrahepatic recurrence. Liver conditions were evaluated using the Fibrosis-4 (FIB-4) index, NAFLD-fibrosis score (NFS), aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), and AST to alanine aminotransferase (ALT) ratio.

Results: Fifty patients who underwent macroscopic curative surgery for pancreatic head cancer were analyzed. We observed LM and extrahepatic recurrences in 15 (30%) and 19 patients (38%), respectively. The extrahepatic recurrence group included two patients with viral hepatitis and one with alcoholic chronic pancreatitis. Preoperative factors and plain CT scans revealed significantly lower platelet levels and liver-to-spleen ratios, respectively, in the extrahepatic recurrence group. The FIB-4 index and NFS were significantly higher in the extrahepatic recurrence group than in the LM recurrence group.

Conclusion: High preoperative FIB-4 Index and NFS scores could be potential predictors for reduced metachronous LM following PD for pancreatic head cancer.